Advancing Nursing Practice in Pain Management

This book showcases the development and evaluation of innovative examples of pain management initiatives by advanced practitioners. It considers each service development or community initiative both in terms of advanced practice nursing and pain management. There is a wide range of examples of innovation in pain management included – from the introduction of ketamine use in one trust, to wider issues around meeting the needs of pain management in the community. The book considers issues including use of research, education and interprofessional working in the advanced practitioner role. Each chapter looks at development of the service, challenges of implementation, evaluation of the service’s success and justifying the importance of the advanced nurse in the service’s achievements. Underlying theory is considered but the focus of each chapter is the translation of knowledge and skills into practice Written by expert advanced nurse practitioners with a wealth of experience in pain management Explores pain management in primary and secondary care, both within and outside the NHS Suitable for qualified nurses, Nurse Practitioners, specialist nurses working in the pain field and nursing students on postgraduate courses on pain management

Contributors’ biographies xi Foreword 1 - Professor Judy Watt-Watson, University of Toronto, Canada xv Foreword 2 - Professor Kim Manley, Head of Practice Development, Royal College of Nursing xvii Preface xix Acknowledgement xxi 1 Introduction to advancing practice in pain management 1 Eloise Carr and Martin Christensen Introduction 1 Advanced practice 1 The context of pain management: definitions and prevalence 5 Advancing practice in pain management 6 Bringing together advanced practice and pain management 7 Conclusions 8 2 Nurse-led femoral nerve block service for patients with fractured neck of femur 11 Mandy Layzell Introduction 11 Pain control 12 Under-treated pain 13 Pharmacokinetics 13 Pharmacodynamics 13 Changes in pain perception 13 Assessment of pain 14 Analgesic drugs and the elderly 14 Femoral nerve block 15 Benefits of FNB 15 Risks of FNB 16 Rationale for a nurse-led service 16 Developing the service 17 Protocol development and training 17 Patient information sheet 18 Patient group directions 18 Data collection and evaluation of the service 19 Training 19 Problems encountered with the training 19 Challenges in implementing a new service 20 Evaluation of the 1-year pilot study 21 Service feedback from staff 23 Service feedback from patients 23 Justifying the advanced nursing contribution 23 Conclusions 25 Acknowledgements 26 3 New directions in acute pain management: ketamine 29 Gillian Chumbley Introduction 29 Developing the service 33 Challenges in implementing a new service or area of practice development 37 Evaluation of using ketamine for pain relief 38 Justifying the advanced nursing contribution 40 Conclusions 42 4 Developing a nurse-led clinic for the treatment of neuropathic pain 45 Eileen Mann Introduction 45 Definitions and causes of neuropathic pain 45 Prevalence of neuropathic pain 46 A proposal and rationale for a nurse-led clinic for sufferers of neuropathic pain 47 Identifying stakeholders 50 Developing a business plan 51 Assessment tools 52 The challenges and reality 54 Evaluation of the service 57 Justifying the advanced nursing contribution 58 Conclusions 58 Appendix 1: Original business plan 59 Appendix 2: Text of an open letter to all local general practitioners informing them of the proposal to commence a nurse-led clinic for painful diabetic neuropathy 63 Appendix 3: Example of a typical letter to a general practitioner, at the time pregabalin was not available for prescription 64 5 Nurse-led strategies to improve patient safety in acute pain management 71 Felicia Cox Introduction 71 Media exposure 72 Injectable medicines 72 Intravenous opioid PCA 72 Epidural analgesia 73 Analgesic medicines and risk 74 Nursing contribution to medicines management 74 New role 74 Blurring of roles 75 Developing the service 75 Oral and PCA analgesia 77 Challenges in implementing the changes in practice 84 Ongoing evaluation and audit 87 Justifying the advanced nursing contribution 88 Conclusions 89 6 Developing an acupuncture service for chronic pain 93 Ruth H Heafield, Christine M Haigh, Christine M Barnes and Elaine Beddingham Introduction 93 Rationale for setting up an acupuncture clinic for pain management 94 Staff development: education and maintaining competencies 102 Clinical governance 105 Conclusions 109 Editors’ note 109 7 The advanced nurse practitioner: developing alliances 113 Ruth Day and Dee Burrows Introduction 113 Alliances and strategic alliances 113 Changing workplaces 114 Skill acquisition 114 Developing entrepreneurial services in pain management 115 The challenge of forming alliances to enable implementation 119 The challenge of maintaining standards 121 Advanced nursing practice and strategic alliances 123 Conclusions 124 Acknowledgements 125 8 An overview of advanced nursing practice in the development of pain clinics in primary care: new ways of working 127 Paul Bibby Introduction 127 Background – an overview of the provision of pain services 128 Developing the service 129 Challenges 132 Evaluation 134 Conclusions 139 Appendix 1: Pain clinic audit 140 9 Development of nurse-led pain management programmes: meeting a community need 143 Dee Burrows Introduction 143 Developing the service 145 Challenges in implementing the service 150 Maintaining standards and evaluating the service 153 Justifying the advanced nursing contribution 158 Conclusions 159 Appendix 1 159 Red flags indicative of possible serious spinal pathology 159 Psychosocial yellow flags – the beliefs and behaviours which may predict poor outcome and which pain management programmes address 159 Acknowledgements 160 10 Nurse prescribing in acute and chronic pain management 163 Trudy Towell and Martin Christensen Introduction 163 Acute pain 165 Chronic pain 165 Rationale for service development 167 Evaluation use of audit and CPD 172 Justifying the advanced nursing contribution to develop nurse prescribing in pain management 176 Conclusions 177 11 Nurses leading the development of interprofessional education in pain management 181 Ann Taylor Introduction 181 Developing a formal educational qualification in pain 184 Challenges in establishing and managing an interprofessional course 187 Evaluation and the use of audit 189 Justifying the advanced nursing contribution 191 Conclusions 192 12 New knowledge for advancing practice in pain management 195 Martin Christensen and Eloise Carr Introduction 195 Advancing practice in pain management 202 Conclusions 204 Index 207